Anthem Blue Cross (HMO, PPO, EPO)
Otezla (apremilast)
Drugs for Pain and Fever : Arthritis and Pain Drugs
  • Available only through Specialty Pharmacy;
  • Prior Authorization: Age Requirement: >= 18
    Duration: 12 Month(s)

  • Step Therapy: Psoriasis (PsO):
    ST Multiple Brands

  • PA Applies
  • Quantity Limit: 2 tablets per 1 day(s).
  • Psoriasis (PsO):
    Age Requirement: >= 18
    Duration: 12 Month(s)
    Documented Diagnosis: No
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    TB Test required: Yes
    History of Plaque Psoriasis: N/A
    Overall % of Body Surface For Initiation: 5
    Overall % of Body Surface For Initiation With Sensitive Areas: Unspecified
    Psoriasis Classification: Moderate-Severe
    Sensitive Area BSA Percent override: Yes

    Psoriatic Arthritis (PsA):
    Age Requirement: >= 18
    Duration: 12 Month(s)
    Documented Diagnosis: No
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    TB Test required: Yes

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